Provider Demographics
NPI:1619845344
Name:TANDUNGANG, BELLA JAVIS
Entity type:Individual
Prefix:
First Name:BELLA
Middle Name:JAVIS
Last Name:TANDUNGANG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14110 KYDAN CT
Mailing Address - Street 2:
Mailing Address - City:BRANDYWINE
Mailing Address - State:MD
Mailing Address - Zip Code:20613-6124
Mailing Address - Country:US
Mailing Address - Phone:240-437-8675
Mailing Address - Fax:
Practice Address - Street 1:14110 KYDAN CT
Practice Address - Street 2:
Practice Address - City:BRANDYWINE
Practice Address - State:MD
Practice Address - Zip Code:20613-6124
Practice Address - Country:US
Practice Address - Phone:240-437-8675
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-10-24
Last Update Date:2025-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA20005499374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide